We assessed factors which may affect union in 32 patients with nonunion of a fracture
of the diaphysis of the femur and 67 comparable patients whose fracture had united.
These included gender, age, smoking habit, the use of non-steroidal anti-inflammatory
drugs (NSAIDs) the type of fracture (AO classification), soft-tissue injury (open
or closed), the type of nail, the mode of locking, reaming nu non-reaming, infection,
failure of the implant, distraction at the fracture site, and the time to full weight-bearing.
Patients with severe head injuries were excluded. Both groups were comparable with
regard to gender, Injury Severity Score and soft-tissue injury. There was no relationship
between the rate of union and the type of implant, mode of locking, reaming, distraction
or smoking. There were fewer cases of nonunion in more comminuted fractures (type
C) and in patients who were able to bear weight early. There was a marked association
between nonunion and the use of NSAIDs after injury (p = 0.000001) and delayed healing
was noted in patients who took NSAIDs and whose fractures had united.